• Sleep Apnea

    How can you tell if you have Sleep Apnea? Ask your spouse, family, or those around you. Here are some questions to ask: 1. Are you a loud, habitual snorer, disturbing your companion? 2. Do you feel tired and groggy in the morning? 3. Do you experience sleepiness and fatigue during the day? 4. Are you overweight? 5. Have you been observed to choke, gasp, or hold your breath during sleep? If you answered yes to one or more of these questions, you should discuss your symptoms with your physician. Blood oxygen saturation is reduced in the entire body during apnea -- sometimes producing serious irregular heartbeats and significantly reduced oxygen to the brain. Common symptoms of Sleep Apnea are a decreased ability to concentrate; loss of energy and/or fatigue; mild to marked depression; irritability; short temper; morning headaches; forgetfulness; anxiety; and, most frequently, excessive daytime sleepiness. Read More
  • Narcolepsy

    Narcolepsy, and related disorders, is typified by the inability to stay awake. Narcoleptics may suddenly fall asleep while they are engaged in an activity (for example, while waiting for a traffic light to change). Attacks are occasionally brought on by laughing, crying, and other strong emotions in a group setting. This illness often goes undiagnosed for years. Read More
  • Insomnia

    Insomnia is an inability to fall asleep or stay asleep. Attacks are often brought on by stress; worry; depression; another illness; persistent pain; and sleeping pill habits. Evaluating insomnia is important even if the condition seems temporary. Read More
  • Other Sleep Disorders

    Some people suffer from nightmares, night terrors, sleep walking, excessive body jerks, or uncontrollable leg movements. These people often get less than four and one-half hours of restorative sleep -something our bodies need. Even though a person spends ten hours in bed, they may only get two hours of restorative sleep. It is important to have your sleep analyzed if you find yourself waking up more tired than when you went to bed. Read More
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Head Injury

By Dr. Peter Bernad

Head injury is a major aspect of Healthcare in the United States. Accidents, hcmicide, and suicide are the major determinants of mortality.

Up-to-date figures indicate that ten million Americans sustain head injury and Post Concussion Syndrome annually. Out of this, in 1980 there were 160 thousand deaths. Approximately 66% of the total number of deaths are caused by accidents and to a very large extent occur as a result of motor vehicle involvement. Not only is this a major aspect of healthcare overall in terms of financial costs estimated to be greater than 75 billion dollars a year, but also the injuries occur to those who are young. Indeed, accidents are the leading cause of death for persons ages 1-44 years, whether black or white, male or female. Society loses a significant proportion of the most physically able to accidents, either temporarily or permanently.

Recently, major newspapers, including the Wall Street Journal, have raised public concern by referring to "mild head injury" or Post Concussion Syndrome as "the silent epidemic" of the 1980's.

I define minor head injury as injury that is sustained without causing either skull fracture or laceration to the brain and in which the individual usually recovers after a short period of unconsciousness and has a very short, if any, hospital stay. These individuals number almost nine million per year. Many of these individuals have persistent symptoms beyond the expected recovery period which now has been thought to be approximately 2-3 months. Almost 100% of these patients have symptoms of headache.

Cervical, thoracic and lumbar pains, dizziness, tinnitus or ringing of the ears, a sense of imbalance, occasionally loss of libido, impotence and abnormal periods, loss of smell and occasionally taste, visual problems, numbness in arms and legs, memory problems (mostly short-term and occasionally intermediate), periods of amnesia and many other symptoms are grouped under the rubric of "Post Concussion Syndrome". I have defined Post Concussion Syndrome into two broad categories:

1) Type I which is benign and in which the prognosis is very good and the patient usually returns to work within approximately six to ten weeks and returns to premorbid functioning. These individuals essentially became normal after this period of recovery.

2) Type II Post Concussion Syndrome represents a group of patients who have persistent symptoms past the ten weeks. Many of those patients, unfortunately, never recover their premorbid state. They freguently do not go back to work, they either lose their jobs or terminate voluntarily. They have persistent symptoms of headache and dizziness, ringing of the ears, numbness, tingling, paresthesias and they go on to have multiple subjective symptoms with no neurological findings and have persistent low level of social and vocational achievement. One of the striking features of this particular group is that they appear to be well, and yet are remarkably impaired.

Impairment of cognitive and intellectual functioning has been well demonstrated and documented following Post Concussion Syndrome. This information goes back to 1944 when intellectual functioning was evaluated hours after concussion and found to be abnormal, especially in measures of speed of thought and excessive fatiguability.

- Besides having a private practice, Dr. Bernad is a Consultant in Neurology with Hospice of Northern Virginia, Arlington; and Dominion Psychiatric Treatment Center in Falls Church. He also has patients at Fairfax Nursing Center.

Dr. Bernad is very interested in neurological research and is the author of several articles. He is Clinical Assistant Professor, Department of Psychiatry, Georgetown University Hospital and Clinical Assistant Professor, Department of Neurology, George Washington University. - Editor